An Analysis of Policy Changes in a Complex Environment

People taking prescription drugs for chronic conditions need to consistently take their medication to manage their illness. When patients have to go to the pharmacy every month (instead of every three months), or pay higher out-of-pocket costs for a prescription, some patients do not comply with prescribing directions. If their health declines, they may use other health care services, raising the medical costs and negating any short-term savings from skipping medications.

Researchers examined the effect of policy changes made to North Carolina’s Medicaid prescription drug program in July 2001 that reduced prescription lengths from 100 to 34 days; and in October 2001 that increased the co-pay for name brand drugs. They compared prescription drug use for six chronic conditions—high blood pressure, diabetes, high cholesterol, seizures, depression and psychosis—in North Carolina to that in Georgia, which has similar demographics and has had a 31-day prescription program for some time.

Researchers found a significant decrease in medication adherence across all six medication classes. Medicaid expenditures decreased among those affected by days-supply decrease. Lower levels of medication adherence did not increase use of other services, however, either because individuals bore additional disease burden or not enough time had elapsed to measure use.